Practice Guidelines

ACIP Approves 2021 Adult and Child/Adolescent Immunization Schedules


Am Fam Physician. 2021 Feb 15;103(4):250-251.

Published online February 12, 2021.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Infants weighing less than 2,000 g born to mothers negative for hepatitis B surface antigen should receive an initial hepatitis B vaccination at hospital discharge or one month of age, whichever comes first.

• Live influenza vaccines should be avoided in people who have received oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous five days, or baloxavir within the previous 17 days.

• Approved mRNA vaccines for SARS-CoV-2 require a second dose of the same vaccine at 21 days for the Pfizer-BioNTech (mRNA-BNT162) vaccine and 28 days for the Moderna (mRNA-1273) vaccine. The CDC is adding additional safety and monitoring systems to current federal vaccine safety programs for these vaccines.

From the AFP Editors

The 2021 adult and child/adolescent immunization schedules have been approved by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and are accessible at Recognizing the difficulty of finding information in footnotes, ACIP introduced simpler and more prominent notes to clarify recommendations. Schedules for adults and children have similar designs, each with clear instructions on the cover page.

Changes to Child/Adolescent and Adult Immunization Schedules

Notable changes to both the child/adolescent and adult schedules include the addition of a new quadrivalent meningococcal vaccine option against meningococcal serotypes A, C, W, and Y for children two years and older and adults, guidance around live influenza immunization after antiviral medication use, an accelerated hepatitis A/B vaccine (Twinrix) dosing schedule for travelers 18 years and older, and further clarification on tetanus-toxoid containing vaccines in wound management.

ACIP continues to recommend routine human papillomavirus (HPV) vaccination for all patients from nine to 26 years of age and with shared clinical decision-making for those 27 to 45 years of age. People with HIV

Author disclosure: No relevant financial affiliations.


1. Centers for Disease Control and Prevention. COVID-19. Understanding mRNA COVID-19 vaccines. Accessed December 4, 2020.

2. Centers for Disease Control and Prevention. COVID-19. Ensuring the safety of COVID-19 vaccines in the United States. Accessed December 4, 2020.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at



Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

More in AFP

More in Pubmed


May 2022

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article